Are we creating a hernia to fix a hernia: long-term hernia rates following robotic inguinal hernia repair

Robotic inguinal hernia repair is one of the fastest-growing procedures in general surgery. Numerous studies have compared minimally invasive surgery (MIS) and open approach to inguinal hernia repairs with generally comparable outcomes, and a trend toward reduced early post-operative pain in MIS. As compared to an open inguinal hernia, robotic transabdominal preperitoneal inguinal repair presents potential hernia sites at the trocar site and inguinal site. This study aims to report long-term hernia rates at these sites in patients who have undergone robotic inguinal hernia repair.

We conducted a retrospective chart review at a high-volume community hospital, analyzing data from 560 patients who underwent elective robotic inguinal hernia repair between 2016 and 2019. The minimum chart assessment period was five years, with an average of 7 years. Recurrence of inguinal hernia and occurrence of trocar site hernia was assessed based on documented physical examination or imaging findings.

Among the 533 patients included, 127 experienced occurrences of at least one type of hernia, resulting in a total of 152 identified hernias: 94 (18%) at the trocar site and 48 (9%) inguinal. This corresponds to a 24% total incidence of hernia occurrence following elective robotic inguinal hernia repair at a 7-year chart assessment.

With a minimum chart assessment period of five years, the overall hernia occurrence rate following robotic inguinal hernia repair approaches 25%, indicating that about 1 in 4 patients return with a hernia. While the majority of hernias occur at the midline trocar insertion site, data for other access approaches remain lacking in our patient population. Further investigation is needed to explore alternative techniques that may help reduce hernia occurrence rates.